title: [Combined epidural-spinal analgesia during labor: a quantitative systematic review of the literature (meta-analysis)].
abstract: OBJECTIVE
  To perform a meta-analysis on the use of combined epidural-intrathecal analgesia during labor, including intrathecal fentanyl and/or morphine compared to usual epidural techniques.
  
  
  METHODS
  A literature search was made looking for randomized clinical trials in MEDLINE, EMBASE and Cochrane Library. The size of the effect for quantitative variables was analyzed by weighted mean difference; for qualitative variables, by odds ratio. Variables analyzed were: labor duration, type of delivery (spontaneous, instrumental and caesarean section), motor blockade, pain, and satisfaction. The analysis used in most cases was a random effects model.
  
  
  RESULTS
  A total of 21 trials, which included 3.646 patients, were selected out of the 38 initially found. The type of delivery variable with its 3 subgroups was the only one to show uniformity (p>Q 0.1; I(2)<50%). There were no differences in the variables analyzed except pain, which was advantageous for the group with intrathecal fentanyl or morphine by 0.55 points out of 10.
  
  
  CONCLUSIONS
  Combined analgesia including intrathecal fentanyl-morphine does not offer significant advantages compared to the standard epidural.
authors.affiliation: Servicio de Anestesiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: pascrib@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Pascual-Ramírez
authors.forename: J
authors.initials: J
authors.lastname: Haya Palazuelo
authors.forename: J M
authors.initials: JM
authors.lastname: Valverde Mantecón
mesh_terms: D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000775:Anesthesia, Spinal; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007743:Labor, Obstetric; D009020:Morphine / Q000008:administration & dosage*; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl
keywords: Analgesia combinada; Analgesia epidural; Analgesia neuroaxial; Analgesia para el parto; Combined analgesia; Epidural analgesia; Intrathecal opiates; Labor analgesia; Meta-analysis; Metaanálisis; Neuraxial analgesia; Opiáceos intradurales